Cerebrovascular disease is commonly known as stroke indicating acute or chronic brain nerve cell necrosis as a result of cerebrovascular occlusion or cerebrovascular rupture. Usually, stroke results in partial or total brain disorder. In severe case, it may lead to sudden death. Healthy brain cells unaffected by stroke may stand a chance of neural plasticity. After stimulation treatment, cortex reorganization might happen to speed up recovery of affected function. Clinically, targeting at recovery training of mobility of stroke patient, therapists combine various therapy theories and techniques to instruct and assist stroke patient to re-learn, adjust with appropriate movement pattern and prohibit inadequate posture. Therefore, the effectiveness of motor re-learning can be achieved. Alternatively, given other sensory participation, effective replacing skill and auxiliary equipment, life skills of stroke patients can be rebuilt to live independent life again.
Later on, scholars combine fundamental theories to further develop diversified treatment techniques, among which compensatory strategies, constraint induce movement therapy (CIMT) and bimanual therapy are three treatment patterns that are widely accepted.
The compensatory strategies reply on the replacement of unaffected side or adjustment of environmental equipment, and increase life independence of stroke patients in the beginning stage. However, excessive dependence prevents affected side from being stimulated and learning subsequently, thereby lowering the degree of recovery of affected side.
The CIMT has been proved to help generate self-movement of patients induced at acute stage of stroke. However, lacking of the reference standard of movement of unaffected side and training of mutual coordination of both sides, the simulation effectiveness of functional movement of daily life associated with patients having higher functional capability at chronic stage is still questioned in doubt. The bimanual therapy is extensively applied to a bimanual movement pattern commonly available in life as training movement thereof, facilitating extension of functional movement of daily life. Also accompanying with training mechanism of dual-brain hemisphere organization, the bimanual therapy is deeply admired by scholars supporting movement learning. However, the actual training and evaluation thereof need be further developed and refined.
Mudie and Matyas gave regular auditory stimulus to stroke patients in 1996, and additionally mounted a movable handle to a self-developed platform for patients to use both hands to perform bilateral equal momentum training featured by using both hands to push and pull with identical movement. As such training pertains to the design of general mechanism, applied force and distance of operation fail to be precisely quantized.
Cauraugh and Kim treated the limbs of affected side of patients with neuromuscular stimulation in 2002, and let the patients to perform bilateral movement training in collaboration with the hand of unaffected side. At last, a block and box test is used to evaluate the effectiveness of the training. Throughout the evaluation process, as observing the number of moving blocks is the only means to evaluate the improved degree of patients and no other instrument involved in measuring force or distance, it is indeed uneasy to ascertain if both hands of patients actually perform bilateral movement or the hand of unaffected side guides the hand of affected side to perform bilateral movement training. Hence, such training may have little significance and fails to accurately quantize effectiveness. Lately, a newly developed movement training mechanism for bilateral upper limbs combined with visual feedback is available, so that both hands of patients hold handles at two ends of a support bar to perform the movement training along left, right, forward and backward directions. Despite being amusing for combining with visual feedback, it is still uncertain if patients use both hands to perform bilateral movement or the hand of unaffected side guides the hand of affected side to perform bilateral movement training. As a result, the training effect is lessened, and the effectiveness of the rehabilitation training fails to be objectively quantized.
Rose brought up another approach in 2005. He put a LED button on a table and requested testees to sit in front of the table. When a light is on, testees are requested to press the LED button with both hands at the same time so as to turn off the light with the fastest speed. The response time of movement and the movement performing time can thus be observed. As such means is uncertain if both hands simultaneously press the button to turn off the light, the starting time of movement recorded for the response time is counted when the movement of the testees is viewed to start by the naked eyes of the testers. Consequently, the way of counting time fails to precisely record the actual performing time duration of testees.
From the above approaches, it is understood that trainings performed clinically at present fail to precisely quantize the training process and the results thereof, and thus fail to ascertain if hands of both sides of patients actually perform bilateral movement or the hand of unaffected side guides the hand of affected side to perform bilateral movement training. Therefore, the hand of affected side fails to be treated with effective training.